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Do Breast Health Recommendations Change with Implants?

September 29, 2018

If you have breast implants, you may wonder if there are different recommendations for detecting breast cancer. With some additional screening options and a few extra considerations, you can put your mind at ease. Here, we break down what your options are for screenings with implants.

Extra views in screening mammograms

For all women who have an average risk of breast cancer, the American Cancer Society recommends women begin yearly screening mammograms at age 40. For patients with breast implants, their mammograms will involve an extra set of views. Sheila Manion, MD, medical director for Kettering Breast Evaluation Centers, explains, “The technologist will take regular views, and then will also try to gently displace the implant and pull the patient’s own glandular tissue forward so that we can see it without the implant.” Because many women who have implants also often have dense breast tissue, Dr. Manion says that some additional screenings in conjunction with mammograms may be beneficial.

For patients with denser tissue, breast ultrasounds can be an effective additional screening option. Ultrasounds are done with sound waves and no radiation, and are better at seeing through dense tissue. However, ultrasounds are not as effective as mammograms at detecting microcalcifications, which are associated with the earliest forms of cancer before a mass is present. For this reason, ultrasounds should be performed in addition to and not instead of mammograms.

Determining your lifetime risk

“Clinical examination and breast self-examination, along with imaging, form the triad of breast health recommendations,” says Dr. Manion. When a woman has implants, she should have her doctor show her where breast tissue ends and the implant begins. This will help in distinguishing between abnormality in her own tissue and what is simply the breast implant itself. Dr. Manion also notes that determining your personal risk level is an important layer when it comes to screening recommendations.
“We help patients determine risk through a cancer risk assessment that asks questions about family history and lifestyle,” explains Dr. Manion. “The questionnaire helps to determine if they yield a 20% or higher lifetime risk for breast cancer.” According to the American Cancer Society, anyone with a 20% or greater risk should also consider a yearly breast MRI.

Additional screening modalities

Breast MRIs can also be a good option for patients with breast implants. Over time, silicone implants can harden, becoming encased in a shell of calcium, which makes it harder to perform effective mammograms or ultrasounds. In this case, an MRI will provide a more detailed study of the breast. Women who opt for MRIs shouldn’t be claustrophobic and cannot have renal failure.

For women with implants who are not good candidates for MRIs, Kettering Health Network offers breast specific gamma imaging (BSGI), in which the patient is injected with a low dose of a tracer fluid, similar to what would be done in a cardiac stress test. Images of the breasts are then taken in the same projections that mammograms are done in. BSGI takes longer than a mammogram, but the breast isn’t held in as tight of a compression as it is during a mammogram.

“Always talk to your provider about alternate screening options if you think you might need them,” says Dr. Manion. “There are many tools and resources available, and we are here to safely guide you through the screening platform that is best for you.”